CDC Alert - Level 2, Practice Enhanced Precautions

Yellow Fever Fatalities Reach Alert-Level in Nigeria

Federal Republic of Nigeria level 2 travel alert issued by the CDC
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Africa (Vax Before Travel)

The Nigeria yellow fever outbreak has intensified during 2019, reaching an alarming level of new Confirmed Cases and a high Case Fatality Rate.

In response, the US Centers for Disease Control and Prevention (CDC) issued a Level 2 Travel Alert for the Federal Republic of Nigeria on December 7, 2019.

This is an important Travel Alert since over 2 million travelers visit Nigeria each year. Nigeria is a country in West Africa with a population of about 200 million residents.

The CDC’s ‘Practice Enhanced Precautions’ advice says ‘travelers visiting Nigeria should receive vaccination against yellow fever at least 10 days prior to travel and should take steps to prevent mosquito bites while there.’

Furthermore, the CDC suggests ‘those never vaccinated against yellow fever should avoid traveling to Nigeria during the outbreak.’

The CDC’s new advice conflicts with the World Health Organization (WHO) travel suggestion published on December 18th. The WHO does not recommend any restrictions on travel to Nigeria on the basis of the information available on this outbreak.’

The WHO says Nigeria is responding to successive yellow fever outbreaks, with nearly a three-fold increase in the number of confirmed cases in 2019 compared to 2018. 

From January through December 10, 2019, a total of 4,189 suspected yellow fever cases were reported across all the 36 states and the Federal Capital Territory in Nigeria.

Sixty-eight percent of the total (197 cases) Confirmed Cases have been reported from 4 Nigerian states, including Bauchi, Katsina, Edo, and Ebonyi.

Moreover, the Case Fatality Rate is 12.2 percent for Confirmed Cases.

There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides lifetime immunity.

On November 5, 2019, an Emergency Operations Centre (EOC) was activated for the 3rd time. 

A national rapid response team has been deployed to affected Nigerian states to support the outbreak response activities including surveillance, case management support and risk communications.

In addition to the existing laboratories in the country, new and operational laboratories have been added to the national laboratory network in Abuja, Edo and Enugu states.

Nigeria is considered a high-risk country by the Eliminate Yellow Fever Epidemics (EYE) strategy says the WHO. This EYE strategy may be further updated or accelerated based on risk, vaccine and implementation feasibility. 

Nigeria is in the process of completing a planned phase-3 vaccination campaign in 2019 and evaluating the recently concluded mass vaccination campaign.

WHO recommends vaccination against yellow fever for all international travelers more than nine months of age going to Nigeria. And, Nigeria also requires a yellow fever vaccination certificate for travelers older than 1 year of age arriving from countries with risk of yellow fever transmission.

Yellow fever vaccines approved by WHO are safe, highly effective and provide life-long protection against infection.

The CDC says for most travelers, 1-dose of yellow fever vaccine provides long-lasting protection. 

However, because of the current outbreak, Nigeria is considered a higher risk. For this reason, if you were vaccinated against yellow fever 10 or more years ago, talk to your doctor about getting a booster dose of vaccine before your travel.

The yellow fever vaccines YF-VAX and Stamaril are available at a limited number of clinics and pharmacies in the USA. 

For this reason, the CDC says to contact yellow fever vaccine providers well in advance of travel. And most importantly, speak with a healthcare provider if you have questions about the yellow fever vaccine, as it is not recommended for some people.

Furthermore, Nigeria is facing several concurrent public health emergencies, including circulating vaccine-derived poliovirus (cVDPV), measles, monkeypox, Lassa fever, and cholera outbreaks.

The CDC suggests speaking with a healthcare provider if you need protective vaccination for these diseases.

Nigeria is included in the CDC’s polio Travel Alert, which was issued on December 11, 2019.

And, the US Embassy in Lagos, Nigeria, posted an Advisory on December 17, 2019, which says ‘There have been reports of harassment when departing the Lekki Market parking area.’

The US Department of State issued a Level 3 Travel Advisory for Nigeria on October 29, 2019. For more information, please read this summary.

Yellow fever vaccine news published Vax-Before-Travel.